PDF(Pubmed)
Abstract：
Subcutaneous metastasis from esophageal cancer (EC), particularly to the chest wall, is a very rare phenomenon. The present study describes a case of gastroesophageal adenocarcinoma that metastasized to the chest wall, invading the fourth anterior rib. A 70-year-old female presented with acute chest pain 4 months after undergoing Ivor-Lewis esophagectomy for gastroesophageal adenocarcinoma. A chest ultrasound revealed a solid hypoechoic mass on the right side of the chest. A contrast-enhanced computed tomography scan of the chest revealed a destructive mass on the right anterior fourth rib (7.5x5 cm). Fine needle aspiration revealed a metastatic moderately differentiated adenocarcinoma to the chest wall. Fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography revealed a large FDG avid deposit on the right side of the chest wall. Under general anesthesia, a right-side anterior chest incision was made and the second, third and fourth ribs were resected with overlying soft tissues, including the pectoralis muscle and overlying skin. The histopathological examination confirmed a metastasized gastroesophageal adenocarcinoma to the chest wall. There are two common assumptions regarding chest wall metastasis from EC. The first one states that this metastasis can occur due to the implantation of the carcinoma during tumor resection. The latter supports the notion of tumor cell dissemination along the esophageal lymphatic and hematogenous systems. Chest wall metastasis from EC invading ribs is an extremely rare incident. However, its likelihood of occurrence should not be neglected following primary cancer treatment.
摘要：
食管癌（EC）皮下转移，特别是胸壁，是非常罕见的现象。本研究描述了一例转移到胸壁的胃食管腺癌，侵入第四根前肋骨.一名70岁的女性在接受胃食管腺癌的Ivor-Lewis食管切除术后4个月出现急性胸痛。胸部超声显示胸部右侧有实质性低回声肿块。胸部对比增强计算机断层扫描扫描显示右前第四肋骨（7.5x5厘米）有破坏性肿块。细针抽吸显示胸壁转移性中分化腺癌。氟脱氧葡萄糖（FDG）-正电子发射断层扫描/计算机断层扫描显示，在胸壁右侧有大量的FDG狂热沉积物。在全身麻醉下,做了一个右侧前胸部切口，第二个切口，切除第三和第四根肋骨，上面有软组织，包括胸肌和上面的皮肤。组织病理学检查证实胃食管腺癌转移到胸壁。关于EC的胸壁转移有两个常见的假设。第一个指出，这种转移可能是由于肿瘤切除期间癌的植入而发生的。后者支持肿瘤细胞沿食管淋巴和血源系统传播的概念。EC侵犯肋骨的胸壁转移是极为罕见的事件。然而,其发生的可能性不应忽视后的原发性癌症治疗。
